Provider Demographics
NPI:1275652455
Name:TWIN FORKS HEMATOLOGY ONCOLOGY PC7
Entity Type:Organization
Organization Name:TWIN FORKS HEMATOLOGY ONCOLOGY PC7
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:EMANUELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-727-7100
Mailing Address - Street 1:1267 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2673
Mailing Address - Country:US
Mailing Address - Phone:631-727-7100
Mailing Address - Fax:631-727-6754
Practice Address - Street 1:1267 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2673
Practice Address - Country:US
Practice Address - Phone:631-727-7100
Practice Address - Fax:631-727-6754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202139207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4498240002OtherDME
NYW86081Medicare ID - Type Unspecified
4498240002Medicare NSC